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Introduction to celiac disease:

The little child just never seems to be feeling well. She doesn’t like to eat. She’s clingy and cranky. It seems like she always has loose stools. She’s not growing well. I wish she would just eat and grow. I wish I could make her happy!

What is celiac disease?

Celiac disease is a food-sensitivity to gluten, which is protein found primarily in wheat, rye, and barley. In those affected, an immune response to gluten damages the lining of the small intestine. The flattened lining of the intestine does not absorb and digest food normally.

Gluten is found in most processed or manufactured foods, so the trigger often escapes notice until somebody finally puts the puzzle pieces together and makes the diagnosis.

Who gets celiac disease?

About 1 in 2000 or 2500 people have been diagnosed with celiac disease. It is believed to be much more common. Some estimate that undiagnosed celiac is present in as many as 1 in 200 people.

The tendency to get celiac disease is inherited genetically. It mostly affects people of European descent. It is also more common in families with diabetes or rheumatoid arthritis. Something in the environment is necessary to trigger the celiac disease in those who are susceptible.

Celiac disease does not begin until gluten is introduced in the diet. Symptoms usually begin between 6 months and 2 years of age, though they can certainly begin at 6 years or 60. There might be a long lag between the time that symptoms appear and a diagnosis is made.

What are the symptoms of celiac disease?

The severity of malabsorption and symptoms varies greatly.

Some children with celiac have severe symptoms including failure to thrive, vomiting, diarrhea, and muscle wasting with a bloated abdomen; while others have only subtle symptoms, such as clinginess, tiredness, or irritability. Most have symptoms that are somewhere in between.

The symptoms can occur in different combinations. Even though this is usually a disease of diarrhea and smelly stools, some children will only have vomiting and failure to thrive as symptoms.

This can make diagnosis difficult, even though it usually seems clear with hindsight. Parents are often frustrated by the lack of answers until the diagnosis is made.

Is celiac disease contagious?

Although symptoms sometimes begin after an episode of viralgastroenteritis, celiac disease is not contagious.

How long does celiac disease last?

This is a lifelong condition. Treatment successfully eliminates the symptoms as long as the person’s diet remains gluten-free.

How is celiac disease diagnosed? Once the diagnosis is suspected, screening blood tests for celiac disease may be performed. Although the early blood tests were notoriously unreliable, they have substantially improved.

The gold standard for diagnosis remains endoscopy and small bowel biopsy, followed by improvement while on a strict gluten-free diet. This improvement may be measured in different ways.

How is celiac disease treated?

The treatment is a strict gluten-free diet. The intestinal lining may show healing in as little as 3 days, and most people have welcome improvement of symptoms within one week!

Nevertheless, the gluten-free diet is life-long. Gluten is not a necessary nutrient. It is not found naturally in fruit, vegetable, fish, meat, milk, eggs, or cheese. Gluten is found in trace amounts or as in ingredient in most manufactured or processed foods. Gluten-free products are becoming more readily available in grocery stores and through online retailers.

Joining a support group for celiac disease is important, both for the support and for education about the disease and about hidden sources of gluten.

Meeting with a dietician is also wise, along with initial supplementation with vitamins and iron. A few children with severe celiac need additional medical therapy in the early months to get growth back on track.

How can celiac disease be prevented?

A gluten-free diet could prevent celiac disease, but is usually not undertaken until a diagnosis is made.

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.